Financial Assistance Policy

The following is a summary of UPMC's Financial Assistance Policy, effective Oct. 10, 2011. This is a general overview of the policy; UPMC will review each application individually to determine whether that patient and treatment qualify for financial assistance.

UPMC's policy is to provide financial assistance for patients who:

Have limited or no health insurance.

Have applied for governmental assistance, such as Medicare or Medicaid, but did not qualify.

Depending on the individual’s need, either free care or reduced patient financial obligations to UPMC hospitals or physicians may be offered. UPMC does not have the authority to waive any charges from physicians or other health professionals who are not employed by UPMC.

UPMC is committed to publicizing its Financial Assistance Program broadly within the communities it serves.

Each patient has the opportunity to apply for financial assistance at all times throughout his or her relationship with UPMC:

Applicants are treated with dignity and respect throughout the process; all information is handled with confidentiality. The patient’s cooperation in providing UPMC with necessary information is crucial to the process.

Typically, a patient is not eligible for UPMC financial assistance until he or she has applied for and been deemed ineligible for federal and Commonwealth of Pennsylvania governmental assistance programs. As a result, UPMC may make resources available to assist patients in enrolling in or applying for such programs. UPMC reserves the right to process the Financial Assistance Application without this determination, provided enough information is available to make an accurate assessment of the patient’s financial situation.

Determination of Assistance Amount

In determining a reasonable and fair level of assistance, UPMC applies a sliding scale.

If a patient’s income is below 400 percent of the federal poverty guidelines, the patient will receive some form of financial assistance.

​Patient's Income

​Amount of Financial Assistance

At or below 200 percent of the federal poverty guidelines:

​The patient is eligible for 100 percent financial assistance.

The fees for UPMC services are completely waived.

​Between 201 and 400 percent of the federal poverty guidelines:

​The patient is eligible for an 85 percent reduction in charges from UPMC hospitals — in other words, the patient pays 15 percent of the charges.

The patient is also eligible for a 75 percent reduction in charges from UPMC physicians — the patient pays 25 percent of the charges.

When financial assistance is less than 100 percent of charges, the fees for which the patient is responsible will not be more than is generally due from Medicare for such services.

In some cases, UPMC may recognize other financial or medical conditions that warrant financial assistance. If a patient's income falls outside the guidelines listed above, please contact UPMC's Financial Assistance Department at 1-800-845-1745 in order to review the circumstances. In any case, UPMC staff may be able to help establish a payment plan that helps patients pay their balance over time.

Exclusions

While UPMC’s Financial Assistance Program covers most services, there are some exclusions, such as, but not limited to:

Cosmetic services

Transplant-related services

Bariatric-related services

Elective reproductive services

Acupuncture

Private duty nursing

Dental services

Services deemed noncovered by Medicare

Other services, at UPMC's discretion

Financial assistance is not typically available for:

Insurance copayments

Insurance deductibles

People who fail to reasonably comply with insurance requirements, such as obtaining authorizations or referrals

Financial assistance is not available for people who opt out of available insurance coverage.

In addition, this policy does not apply to international patients who come to Pennsylvania in order to seek treatment from a UPMC provider.

Quality Assurance

To provide patients with a quality Financial Assistance Program, UPMC:

Performs random audits of applicable patient accounts to ensure that financial assistance is communicated and administered in compliance with the terms of this policy.

For help in finding a doctor or health service that suits your needs, call the UPMC Referral Service at 412-647-UPMC (8762) or 1-800-533-UPMC (8762). Select option 1.

UPMC is an equal opportunity employer. UPMC policy prohibits discrimination or harassment on the basis of race, color, religion, ancestry, national origin, age, sex, genetics, sexual orientation, gender identity, marital status, familial status, disability, veteran status, or any other legally protected group status. Further, UPMC will continue to support and promote equal employment opportunity, human dignity, and racial, ethnic, and cultural diversity. This policy applies to admissions, employment, and access to and treatment in UPMC programs and activities. This commitment is made by UPMC in accordance with federal, state, and/or local laws and regulations.

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For UPMC Mercy Patients: As a Catholic hospital, UPMC Mercy abides by the Ethical and Religious Directives for Catholic Health Care Services, as determined by the United States Conference of Catholic Bishops. As such, UPMC Mercy neither endorses nor provides medical practices and/or procedures that contradict the moral teachings of the Roman Catholic Church.